Category: Statistics

J Pediatr Gastroenterol Nutr. 2021 Jun 28. doi: 10.1097/MPG.0000000000003220. Online ahead of print.

ABSTRACT

OBJECTIVE: Cannabis Hyperemesis Syndrome (CHS) is characterized by recurrent episodes of intractable emesis associated with heavy use of cannabis. Recognition of CHS can be problematic due to the lack of specific biomarkers, which can point the clinician to the diagnosis. We present, retrospectively, a series of adolescent/young adult patients who presented to a pediatric gastroenterology (GI) service with acute on chronic nausea and vomiting, subsequently found to have CHS with associated elevated urinary cannabis metabolite concentrations.

METHODS: We describe 15 patients referred to our pediatric GI division for intractable emesis with spot urinary cannabis metabolite carboxy-THC (THC-COOH) concentrations from January 1, 2018 through April 20, 2019. Urinary testing was performed using gas chromatography mass spectrometry (GC-MS) in a manner consistent with CLIA requirements at Mayo Clinic laboratory (Rochester, MN). The laboratory cutoffs were 3.0 ng/mL. Data was extracted via chart review and analyzed via online statistical application.

RESULTS: Fifteen patients (7 females, 8 males) were studied with an average age of 17.7 years. All patients reported frequent cannabis use for at least 1 month and exhibited intractable, non-bilious emesis for at least 2 weeks. Twelve patients also reported weight loss. Two patients had underlying gastrointestinal disease (one with Crohn’s Disease and one with irritable bowel syndrome). All patients had essentially normal GI workup including laboratory tests, imaging studies and endoscopies.Fourteen of 15 patients had urinary THC-COOH concentrations > 100ng/mL, with 7 individuals exhibiting levels > 500ng/mL. One patient had a urinary TCH-COOH concentration level under 100ng/mL had not used cannabis for 2 weeks. Most other patients had used cannabis within 2 days of providing a urine sample. The Binomial test for CHS patients with urinary THC-COOH levels over 100ng/mL was significant with a p-value of < 0.0005 (one tail test).

CONCLUSION: Cannabis Hyperemesis Syndrome is associated with an elevated urinary THC-COOH level usually exceeding 100ng/mL, which is indicative of significant chronic cannabis exposure. In patients with a history consistent with CHS, urine THC-COOH testing may help guide the diagnostic evaluation of these patients and decrease the need for further workup.

PMID:34224490 | DOI:10.1097/MPG.0000000000003220

Pain. 2021 Jun 29. doi: 10.1097/j.pain.0000000000002385. Online ahead of print.

ABSTRACT

Quantitative Sensory Testing (QST) can be useful to identify high-risk patients for the development of chronic postsurgical pain (CPSP). This systematic review aims to assess if presurgical sensory sensitivity measured using QST is associated with acute and CPSP after total joint arthroplasty.A systematic search was performed in Sep/2020 in PubMed, EMBASE, Web of Science and Scopus, using terms related to total joint arthroplasty and QST. Prospective studies were included if they reported an association between presurgical QST and postsurgical pain in adults with osteoarthritis undergoing primary unilateral total joint arthroplasty.From 2994 identified studies, 18 met the inclusion criteria (1869 patients). Total knee arthroplasty was the most common surgery (16 studies) and pressure pain threshold (PPT) was the most common test (11 studies), followed by dynamic measures (9 studies). Postsurgical pain was assessed at acute (5 studies), subacute (2 studies) and chronic (13 studies) time points. Risk of bias was assessed using the Quality in Prognosis Studies Tool, and evaluated as low-to-moderate in most domains. Fourteen studies reported at least one statistically significant association between QST and pain (acute: 4 studies, subacute: 1 study, chronic: 9 studies). PPT was associated with postsurgical pain in 6 studies (out of 11, 55%), heat pain threshold in 2 (out of 6, 33%), conditioned pain modulation in 1 (out of 6, 17%) and temporal summation of pain in 5 (out of 8, 63%). The predictive role of presurgical QST for post-arthroplasty pain remains unclear, mainly due to heterogeneous methodologies and inconsistent results.

PMID:34224493 | DOI:10.1097/j.pain.0000000000002385

J Cataract Refract Surg. 2021 Jun 28. doi: 10.1097/j.jcrs.0000000000000734. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the accordance and repeatability of tomographic parameters measured by a novel Swept-Source optical coherence tomographer (SS-OCT, ANTERION), a rotating Scheimpflug camera (RSC, Pentacam) and a dual Scheimpflug-Placido system (DSP, Galilei G6).

SETTING: Department of Ophthalmology of Univ. Hospital Carl Gustav Carus, Dresden, Germany.

DESIGN: Prospective reliability analysis.

METHODS: Thirty randomly selected eyes of 30 healthy participants were enrolled in this study. Normal tomography were ensured by bilaterally evaluating appropriated parameters using RSC. All subjects received three consecutive measurements on each device by the same operator and in the uniform order RSC, SS-OCT and DSP. Anterior (ACP) and posterior (PCP) corneal parameters such as flat and steep keratometry and corneal thickness were analyzed. Repeatability was assessed by using a coefficient of repeatability (CR) and a coefficient of variation (CV). Agreement between RSC and SS-OCT as well as RSC and DSP were shown by Bland-Altman plots (BA).

RESULTS: CR of ACP did not exceed 0.5 D. There were no statistical differences in repeatability of ACP obtained from the three devices (P>0.05). For PCP and corneal thickness there was statistically significant higher repeatability mostly found for SS-OCT as opposed to RSC and DSP (P<0.05). For a wide range of analyzed parameters there were large limits of agreement (95%-LoA) found between the devices.

CONCLUSION: The SS-OCT showed highly repeatable measurements in healthy subjects regarding anterior, posterior and corneal thickness parameters. Repeatability of ACP did not differ between the devices. A mostly wide range of 95%-LoA prevents interchangeability between the devices.

PMID:34224476 | DOI:10.1097/j.jcrs.0000000000000734

J Cataract Refract Surg. 2021 Jun 28. doi: 10.1097/j.jcrs.0000000000000737. Online ahead of print.

ABSTRACT

PURPOSE: To compare corneal endothelial damage from longitudinal and torsional ultrasound during phacoemulsification.

SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

DESIGN: Experimental Study.

METHODS: Nine New Zealand white rabbits underwent bilateral surgery. After incision, the Intrepid Balanced tip of the Centurion (Alcon) Ozil handpiece was inserted into the anterior chamber and the following settings were used: 50 mL/minute flow, 70 mmHg intraocular pressure, 600 mmHg vacuum, and 60% longitudinal (one eye) or torsional (contralateral eye) ultrasound for 30 seconds. Cumulative dissipated energy (CDE) was noted. After euthanasia and enucleation, the corneas were removed, stained with trypan blue/alizarin red, and photographed (X400 photographs from 5 specific areas, and 1 overview photograph from each corneal button). The ImageJ program was used to evaluate cell damage and loss in the photographs obtained from each cornea.

RESULTS: Cavitation bubbles around the phaco tip was generally observed in the longitudinal group. CDE was 17.4 +/- 0.58 and 6.93 +/- 0.15 in the longitudinal and torsional groups, respectively (P = 0.003). The percentage of intact cells was statistically higher in the torsional group, and the percentage of lost cells was statistically higher in the longitudinal group (P = 0.003). This was observed in the analysis of the X400 photographs, as well as the overview photographs.

CONCLUSION: This study suggests that torsional ultrasound was associated with significantly less corneal endothelial cell damage than classical longitudinal tip motion, providing further insight on mechanisms of corneal endothelial damage during phacoemulsification.

PMID:34224479 | DOI:10.1097/j.jcrs.0000000000000737

J Cardiovasc Nurs. 2021 Jul 1. doi: 10.1097/JCN.0000000000000832. Online ahead of print.

ABSTRACT

BACKGROUND: Mental distress is reported internationally among patients with cardiac disease. A Danish survey found that 25% of patients with cardiac disease experienced symptoms indicating anxiety and that anxiety was associated with an increased risk of death.

AIM: The aims of this study were to (1) compare cause of death patterns among deceased cardiac patients with anxiety to those without anxiety and (2) examine the association between anxiety symptoms and specific causes of death.

METHODS: We used data from the DenHeart survey to evaluate symptoms of anxiety at discharge by using the Hospital Anxiety and Depression Scale. Data on mortality in the 3 years after discharge and cause of death according to International Classification of Diseases-10 classification came from national registers. Cause of death was compared between patients with and without anxiety using χ2 tests. The association between symptoms of anxiety and cause of death was investigated using logistic regression.

RESULTS: Of 12 913 patients included, a total of 1030 (8%) died within 3 years. After 1 year, 4% of patients with anxiety symptoms had died versus 2% of patients without; after 3 years, the proportions were 9% versus 8%, respectively. Almost all died of natural causes irrespective of anxiety symptoms. No statistically significant differences were found regarding the cause of death between patients with and without anxiety.

CONCLUSION: Despite higher mortality rates in patients with cardiac disease with anxiety symptoms, the pattern of cause of death was identical for patients with cardiac disease with and without anxiety symptoms. It seems that an acceleration of morbid processes leading to mortality is more likely than a difference in cause of death. However, further research is needed to better understand the behavioral and pathophysiological processes that cause the higher mortality seen among patients reporting symptoms of anxiety.

PMID:34224466 | DOI:10.1097/JCN.0000000000000832

Epidemiology. 2021 Jun 24. doi: 10.1097/EDE.0000000000001381. Online ahead of print.

ABSTRACT

Quantitative bias analyses allow researchers to adjust for uncontrolled confounding, given specification of certain bias parameters. When researchers are concerned about unknown confounders, plausible values for these bias parameters will be difficult to specify. Ding and VanderWeele developed bounding factor and E-value approaches that require the user to specify only some of the bias parameters. We describe the mathematical meaning of bounding factors and E-values as well as the plausibility of these methods in an applied context. We encourage researchers to pay particular attention to the assumption made, when using E-values, that the prevalence of the uncontrolled confounder among the exposed is 100% (or, equivalently, the prevalence of the exposure among those without the confounder is 0%). We contrast methods that attempt to bound biases or effects and alternative approaches such as quantitative bias analysis. We provide an example where failure to make this distinction led to erroneous statements. If the primary concern in an analysis is with known but unmeasured potential confounders, then E-values are not needed and may be misleading. In cases where the concern is with unknown confounders, the E-value assumption of an extreme possible prevalence of the confounder limits its practical utility.

PMID:34224472 | DOI:10.1097/EDE.0000000000001381

Eye Contact Lens. 2021 Jul 1. doi: 10.1097/ICL.0000000000000816. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the potential effects of switching to online lecture format on dry eye symptoms and dry eye disease (DED) risk factors.

METHODS: An anonymous cross-sectional online survey was conducted in 812 university students (mean age, 21.5±4.0 years). Participants were classified according to the number of hours the participants took online lectures into online students or in-person students. Respondents completed a total of three DED questionnaires (Ocular Surface Disease Index [OSDI]; 5-item Dry Eye Questionnaire; 8-item Contact Lens Dry Eye Questionnaire) and were surveyed on dry eye risk factors contemplated by the Tear Film and Ocular Surface Society Dry Eye Workshop II in addition to other factors potentially linked to dry eye.

RESULTS: Five hundred twenty-three subjects (64.4%) were classified into the online group and 289 (35.6%) into the in-person group. No statistically significant age (P=0.266) or sex (P=0.423) differences were found between groups. Students taking online lectures used the computer more, spent less time outdoors, practised more exercise, wore a face mask for less time, experienced fewer allergies and fewer psoriasis episodes, and obtained a higher OSDI score (P<0.029 for all). Multivariate logistic regression analysis revealed that the hours of online lectures taken per week was independently associated with having a positive OSDI score (P=0.022).

CONCLUSIONS: Taking online lectures is independently associated with having dry eye symptoms. Despite a lower prevalence of DED risk factors, a higher computer use is probably behind the greater ocular dryness reported by online students.

PMID:34224445 | DOI:10.1097/ICL.0000000000000816

J Craniofac Surg. 2021 Jun 30. doi: 10.1097/SCS.0000000000007760. Online ahead of print.

ABSTRACT

This study aimed to compare the upper-airway morphology between strictly matched Syrian (n = 43) and Hungarian (n = 43) adolescents with Class II/1 malocclusion and identify potential associations between upper airway depths and skeletofacial characteristics. Lateral cephalograms were analyzed, and independent-samples tests and correlation coefficients were used for the statistical analyses. The upper-pharyngeal airway was significantly narrower and the soft palate angle was significantly greater in the Syrian adolescents. Alternatively, the hyoid bone was more posteriorly positioned in the Hungarian adolescents when compared to their counterparts. Depths of the upper and middle pharynx were moderately correlated with sagittal and vertical skeletal dimensions only among Syrian subjects. The depth of the lower pharynx was moderately correlated with hyoid bone position, cervical length, and lip-chin-throat angle only among Hungarian subjects. These findings might have potential implications for optimizing the effects of orthognathic/orthodontic treatments on airway structures in these 2 groups.

PMID:34224460 | DOI:10.1097/SCS.0000000000007760

Appl Immunohistochem Mol Morphol. 2021 Jul 2. doi: 10.1097/PAI.0000000000000949. Online ahead of print.

ABSTRACT

We performed a pilot study in anticipation of using long-aged precut formalin-fixed paraffin-embedded tissue sections stored in real-world conditions for translational biomarker studies of topoisomerase 2A (TOP2A), Ki67, and human epidermal growth factor receptor 2 (HER2) in endometrial cancer. Formalin-fixed paraffin-embedded tissue blocks or unstained slides or both from GOG-0177 were collected centrally (1999-2000) and stored at room temperature. During 2004 to 2011 specimens were stored at 4°C. Matched pairs of stored slides and freshly cut slides from stored blocks were analyzed for TOP2A (KiS1), Ki67 (MIB1), and HER2 (HercepTest) proteins. To assess DNA stability (HER2 PathVision), fluorescence in situ hybridization (FISH) was repeated on stored slides from 21 cases previously shown to be HER2 amplified. Immunohistochemistry (IHC) staining intensity and extent, mean FISH copies/cell, and copy number ratios were compared using the κ statistic for concordance or signed rank test for differences in old cut versus new cut slides. IHC results reflected some protein degradation in stored slides. The proportion of cells with TOP2A staining was lower on average by 12% in older sections (P=0.03). The proportion of Ki67-positive cells was lower in stored slides by an average of 10% (P<0.01). Too few cases in the IHC cohort were FISH positive for any conclusions. HER2 amplification by FISH was unaffected by slide storage. We conclude that use of aged stored slides for proliferation markers TOP2A and Ki67 is feasible but may modestly underestimate true values in endometrial cancer. Pilot studies for particular storage conditions/durations/antigens to be used in translational studies are warranted.

PMID:34224438 | DOI:10.1097/PAI.0000000000000949

J Occup Environ Med. 2021 Jul 1. doi: 10.1097/JOM.0000000000002310. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study is to evaluate whether the exposure to a low dose of Nickel could determinate a variation in levels of progesterone in outdoor workers.

MATERIALS AND METHODS: 261 subjects were divided by gender, task, age, seniority and cigarette smoking habit. For each workers was evaluated the dose of blood progesterone and urinary nickel.The statistical analysis was performed.

RESULTS: The Pearson correlation showed a statistically significant correlation between urinary nickel levels and progesterone. The Multiple linear regression showed a significant correlation between progesterone and urinary nickel in the total sample and in the subgroups of smokers and workers with tasks of traffic direction.

CONCLUSIONS: The results of our study suggest that occupational exposure to low doses of nickel present in urban pollution may influence to progesterone levels in outdoor workers.

PMID:34224421 | DOI:10.1097/JOM.0000000000002310